APPLICATION FOR PARTTIME EMPLOYMENT - Anaheim Ducks

APPLICATION FOR PART­TIME EMPLOYMENT
Position: ___________________ Desired Hourly Rate: _____________
Last Name First Name Date
Address Street City State Zip Code Phone Number Email Address
Are you at least 18 years of age or older? Yes No
EMPLOYMENT HISTORY
List the most recent information first. List U.S. Military Service as a job.
From To
Mo/Yr Mo/Yr Company Name Address Telephone Number
Wage/Rate May we contact this Position Held Supervisor Reason for leaving
$ Employer?
Description of Job Duties
From To
Mo/Yr Mo/Yr Company Name Address Telephone #
Wage/Rate May we contact this Position Held Supervisor Reason for leaving
$ Employer?
Description of Job Duties
From To
Mo/Yr Mo/Yr Company Name Address Telephone #
Wage/Rate May we contact this Position Held Supervisor Reason for leaving
$ Employer?
Description of Job Duties
EDUCATION
Highest grade completed 1 2 3 4 5 6 7 8 9 10 11 12 1 2 3 4 1 2 3 4 Name of last school attended ____________________
Vocational or trade school ____________________________ Course of study _______________________________________
Anaheim Arena Management, Anaheim Ducks Hockey Club, and Anaheim Ice Management are equal opportunity employers that do not discriminate because of sex, age,
race, color, religious creed, marital or veterans status, citizenship, national origin, ancestry, disability, obligation to serve in the armed forces of the US or any other
characteristic protected by applicable federal, state or local laws.
GENERAL INFORMATION
Indicate job related trade license, internships served, foreign languages, special skills, etc.
Describe prior job related experience and equipment operated.
Have you previously been a supervisor? Yes No If yes, what was your title?
How were you referred to our organization? ____________________________________
Are you either a US citizen or an alien legally authorized to work in the US? Yes No
If you answer yes and are offered employment by our company, you must complete the I­9 form required by the US Immigration and Naturalization Service and provide
documentation to verify your identity and eligibility to work in the US no later than three business days after your date of hire.
Except for the offense of possession of less than an ounce of marijuana for your personal use more than two years ago, have you ever
been convicted of a crime?* Yes No
If yes, please state the circumstances. _______________________________________________________________________________
______________________________________________________________________________________________________________
______________________________________________________________________________________________________________
Have you ever been convicted of the crime of possession of less than an ounce of marijuana for personal use within the
past two years?* Yes • No
If yes, please state the circumstances. ______________________________________________________________________________
_____________________________________________________________________________________________________________
_____________________________________________________________________________________________________________
Are you currently under arrest for any crime, other than the aforementioned crime of possession of less than one ounce of marijuana
more than two years ago, which has yet to be adjudicated, pending trial?* Yes • No
If yes, please state the circumstances. ______________________________________________________________________________
_____________________________________________________________________________________________________________
_____________________________________________________________________________________________________________
* NOTE: In responding to this request, we are not asking you to disclose any information concerning an arrest or detention which did not result in
a conviction, or information concerning a referral to, and participation in, any pretrial or post­trial diversion program. Answering "yes" to any of
these questions may not necessarily disqualify you from the position desired. Each action and explanation will be weighted/considered in
relationship to the position for which you are applying.
P R O F E S S I O N A L R E F E R E N C E S
List two people who have worked with you in the past and are not related to you who can comment on your professional character and
work ethic.
Name Title Phone Number Years Known Working Relationship
Name Title Phone Number Years Known Working Relationship
AVAILABILITY
Please CIRCLE the DAYS and HOURS you are able to work:
SUNDAY (AM) 7 8 9 10 11 (PM) 12 1 2 3 4 5 6 7 8 9 10 11 12
MONDAY (AM) 7 8 9 10 11 (PM) 12 1 2 3 4 5 6 7 8 9 10 11 12
TUESDAY (AM) 7 8 9 10 11 (PM) 12 1 2 3 4 5 6 7 8 9 10 11 12
WEDNESDAY (AM) 7 8 9 10 11 (PM) 12 1 2 3 4 5 6 7 8 9 10 11 12
THURSDAY (AM) 7 8 9 10 11 (PM) 12 1 2 3 4 5 6 7 8 9 10 11 12
FRIDAY (AM) 7 8 9 10 11 (PM) 12 1 2 3 4 5 6 7 8 9 10 11 12
SATURDAY (AM) 7 8 9 10 11 (PM) 12 1 2 3 4 5 6 7 8 9 10 11 12
CERTIFICATION STATEMENT
I hereby certify that the answers given by me to the foregoing questions and statements made are true and correct, without reservations of
any kind whatsoever. I understand that any job offer is contingent upon my providing the documentation required by immigration
Reform Control Act. If employment is obtained under this application, I will willingly comply with all orders, rules and regulations of
Anaheim Arena Management, Anaheim Ducks Hockey Club, and Anaheim Ice Management (the Company). I understand that nothing
contained in this employment application or in the granting of an interview is intended to create a contract between me and the company
for either employment or the provision of benefits and that an offer of employment shall not be construed as a guarantee of continued
employment. If an employment relationship is established subsequent to the date of this application, I will have the right to terminate my
employment at any time with or without cause and the company will have a similar right. I also understand that my employment may be
terminated with or without cause or advance notice, at any time.
I agree that my employment with the company is predicated upon my ability to mentally and physically perform the essential functions
of the job for which I am applying which may be evaluated through a physical examination after an offer of employment is made. I
understand that I may be required to submit to a blood and urine test to detect drug or alcohol usage. I further understand that the results
of these tests, which will be kept confidential, may be used by the company to determine my suitability for employment or continued
employment, as the case may be.
I also authorize my former employers, schools and personal references to give any information they may have regarding me, whether or
not it is contained in a written record. I hereby release them and their companies from all liability for issuing same. It is understood that
the statements made by me in this application are subject to investigation by the company and that, upon investigation, if anything
contained in this application is found to be false or misleading, I will be subject to immediate discharge from employment and agree to
hold the company and the references harmless in that event. I understand that no promise, representation, agreement, practice or policy
contrary to the forgoing is binding on the company unless made in writing signed by an officer of the company.
Signature of the Applicant _________________________________________________ Date ______________________________
EMERGENCY CONTACT INFORMATION
Employee’s Name: ___________________________________________
In the event of an emergency, I authorize a represented individual from
Anaheim Arena Management, LLC, Anaheim Ducks Hockey Club, LLC,
Anaheim Ice Management, LLC, Corona Roller Rink, LLC or Huntington Beach
Roller Rink, LLC to contact the individual(s) listed below:
____________________________________________________
Full Name
_________________________________________________________________________
Relationship to Employee
_________________________________________________________________________
Street Address
___________________________________ ________________ ________________
City State Zipcode
(_____)___________________________________
Telephone Number
(______)__________________________________
Alternate Telephone Number
____________________________________________________
Full Name
_________________________________________________________________________
Relationship to Employee
_________________________________________________________________________
Street Address
___________________________________ ________________ _________________
City State Zipcode
(_____)___________________________________
Telephone Number
(______)__________________________________
Alternate Telephone Number
______________________________________________________________ __________________________
Employee Signature Date
ANAHEIM ICE CONSENT, INDEMNIFICATION, WAIVER AND RELEASE AGREEMENT (ADULT)
FOR AND IN CONSIDERATION of my (the undersigned) in activities at and the use of any of the premises and facilities
commonly know as Anaheim ICE and any equipment supplied to the undersigned in connection therewith (collectively, “Participation”),
to the fullest extent permitted by applicable laws, I agree as follows:
1. I acknowledge and I am aware of the hazards, dangers and risks (inherent or otherwise) in connection with the
Participation, including, without limitation, property damage, property loss, property theft, economic loss, accident, minor injury or
serious injury (known or unknown), which may include permanent disability or paralysis, or death to myself, to other participants, to
spectators or other third parties. I further acknowledge that there are natural factors and occurrences which may impact on or affect
the safety of the Participation. I warrant that I am in good health and have no physical conditions that would prevent me from acting in
connection with the Participation. I assume full responsibility for, and all risk of, any accident, bodily injury, death, property
loss, property theft or property damage that may result for any reason, including by acts of negligence, in connection with the
Participation, whether caused by Anaheim Ice Management, LLC (“AIM”) and/or its respective parent, related, affiliate and
subsidiary companies (and their respective owners, officers, directors, employees or agents) (collectively, the “Releasees”),
me, any third persons or otherwise.
2. If I become injured or ill as a result of the Participation, I authorize the Releasees to administer, or cause and
consent to the administration of, whatever first aid, medical care, dental care or other treatment and medications as may be necessary
under the circumstances, including treatment by a physician, emergency medical technician, dentist or hospital (“Treatment”), although
I acknowledge that the Releasees have no obligation to do so and that the Releasees do not endorse the services of any physician or
hospital that may provide such Treatment. I understand that the Releasees will have no obligation to pay any such costs of any
Treatment and agree to reimburse the Releasees for any such costs incurred.
3. I RELEASE, AGREE NOT TO SUE AND AGREE TO INDEMNIFY AND HOLD HARMLESS THE RELEASEES of
and from any and all claims, causes of action, suits, demands, damages, losses, liabilities, costs, expenses and any actions
of any kind whatsoever (collectively, "Claims"), known or unknown, existing now or in the future, that I, my heirs, executors,
administrators, next of kin, assigns or any third party may now or hereafter have against the Releasees, arising in any way as a result
of or in connection with the Participation and any Treatment, including, without limitation, any property damage, property loss, property
theft, bodily injuries, disability, death or other damage suffered by me, my heirs, executors, administrators, next of kin and assigns or
any other party and regardless of any fault or passive or active negligence on the part of the Releasees, myself or any third party. I
expressly waive and relinquish all rights and benefits afforded by California Civil Code Section 1542 and do so understanding and
acknowledging the significance of this specific waiver of Section 1542. Section 1542 states as follows:
“A GENERAL RELEASE DOES NOT EXTEND TO CLAIMS WHICH THE CREDITOR DOES NOT KNOW OR SUSPECT TO
EXIST IN HIS FAVOR AT THE TIME OF EXECUTING THE RELEASE, WHICH IF KNOWN BY HIM MUST HAVE
MATERIALLY AFFECTED HIS SETTLEMENT WITH THE DEBTOR.”
4. I grant to the Releasees a non-exclusive license to use my likeness, image, photograph and/or name in connection
with the marketing, promotion and/or advertising of Anaheim ICE and/or the Anaheim Ducks in any media known and unknown or
hereinafter developed without geographic or time restrictions.
5. This Agreement constitutes my entire understanding regarding the subject matter of this Agreement and supersedes
any prior statements, agreements or representations (written or oral) regarding that subject matter. No oral representations,
statements or inducements apart from this Agreement as written have been made to me. I agree that this Agreement is intended to be
as broad and inclusive as is permitted by the law of the State of California and that if any portion thereof is held invalid, such invalidity
will not affect any other provision that can be given full effect without the invalid provision. The laws of the State of California shall
apply to and govern this Agreement, without regard to conflicts of laws principles, and I consent to the jurisdiction and venue of the
federal, state and local courts located in Orange County, California.
6. I have carefully read this Agreement, and I know and understand what it means, including that it is a complete waiver
and release of liability and promise to indemnify and not to sue or make a claim. My signature below is my own free and voluntary act
and I intend this Agreement to be legally binding on me. I certify that I am at least 18 years old.
Signature: ___________________________________________________________________ Date: _______________________________
Print Name: __________________________________________________________________
Address: ____________________________________________________________________
Phone #:(______)______________________________________________________________
aimllc/AdultWaiver.Form.05.2009